Prepubertal Depression Research Articles

The Long-Term Outcomes of Prepubertal Depression and Internalizing Problems: A Scoping Review.

After participating in this activity, learners should be better able to:• Discuss whether prepubertal depression shows longitudinal continuity with depression in adulthood.• Summarize existing literature on adult emotional and functional outcomes of prepubertal depression and internalizing problems. Adolescent- and young adult-onset depression are common, recurrent, and can cause significant distress and psychosocial impairment across the life span, but recognition of prepubertal internalizing problems and depression, along with their prevalence, clinical course, and long-term outcomes, remains elusive. To examine whether prepubertal depression, which can manifest differently from adult depression, shows longitudinal continuity with depression in adulthood, and to summarize existing literature on adult emotional and functional outcomes of prepubertal depression and internalizing problems. A scoping review was conducted for peer-reviewed cohort articles published between 2000 and 2020 using PubMed and PsycINFO. From 4309 identified references, 17 articles were included. Prepubertal depression confers increased risk of recurrence of depression in adulthood, with similar findings for prepubertal internalizing problems. No studies found prepubertal depression or internalizing problems predicting adult substance abuse, and no studies asked about adult bipolar diagnoses. More research is needed to draw clear conclusions regarding their implications for other psychiatric, medical, or psychosocial outcomes. The reviewed studies provide limited evidence that prepubertal depression onset predicts adult depression. The small evidence base and heterogeneous methodological assessments may limit, however, the ability to draw meaningful conclusions about the long-term course of prepubertal-onset depression. Well-designed studies with longer follow-up and multiple assessments in adulthood are needed to clarify and assess the potential effects of prepubertal depression on adult health and functioning. This information will eventually become available as the samples in recently initiated longitudinal cohort studies of children mature further.

Family-based interpersonal psychotherapy is a promising treatment for preadolescent depression

ABSTRACT FROM: Dietz LJ, Weinberg RJ, Brent DA, et al . Family-based interpersonal psychotherapy for depressed preadolescents: examining efficacy and potential treatment mechanisms. J Am Acad Child Adolesc Psychiatry 2015;54:191–9....

Genetics of childhood and adolescent depression: insights into etiological heterogeneity and challenges for future genomic research

There is heterogeneity between depression in childhood, adolescence and adulthood in terms of the gender composition of affected cases, prevalence, rates of recurrence and risk factors. This raises complex questions for refining the phenotype for molecular genetic studies of depression and the selection of appropriate proband groups. This article aims to provide a review of issues arising from family, twin and adoption studies of relevance to molecular genetic studies, and to summarize molecular genetic findings on childhood/adolescent depression. While retrospective studies of adults suggest greater familial aggregation among those with an earlier age of onset, prospective studies do not confirm this association. In fact, taken together, evidence from family and twin studies suggests that prepubertal depression is more strongly associated with psychosocial adversity, is less heritable and shows lower levels of continuity with adult depression than either adolescent or adult depression. Adolescent depressive symptoms and disorder show similar levels of heritability to depression in adult life, although there is only one twin study of adolescent depressive disorder, and heritability estimates of depressive symptoms vary widely between studies. This variability in heritability estimates is partly attributable to age and informant effects. Adoption studies and other intergenerational transmission designs show that the transmission of depression between parents and children involves genetic and environmental processes, with converging evidence that environmental processes are most important. Molecular genetic studies of childhood/adolescent depression have to date used a candidate gene approach and focused on genes already examined in adult studies. Prospective longitudinal studies of community and high-risk samples are needed to clarify issues of etiological heterogeneity in depression, and these should in turn inform the planning of molecular genetic studies.

The FDA Pediatric Advisories and Changes in Diagnosis and Treatment of Pediatric Depression

The FDA Pediatric Advisories and Changes in Diagnosis and Treatment of Pediatric Depression

A drug utilisation study of antidepressants in children and adolescents using the General Practice Research Database

Aims: To characterise prescribing patterns of antidepressants (ATDs) to children and adolescents aged ⩽18 years in the UK. Methods: Subjects issued at least one ATD prescription between 1 January 1992...

Psychiatric disorders in the relatives of depressed probands I. Comparison of prepubertal, adolescent and early adult onset cases

Research with adults suggests that early onset of depression is associated with increased rates of depression among relatives. This paper presents results of a family study that tested the hypothesis that prepubertal depression was associated with a greater familial loading of depression than the postpubertal form, which in turn had a greater familial loading than adult onset depression. Probands were from a child to adult longitudinal study. Psychiatric disorders among relatives were assessed with family interview and family history methods ‘blind’ to all findings regarding the proband. Contrary to expectation, familial rates of depression did not differ significantly between the groups. However, manic disorders tended to be more common among the relatives of postpubertal depressed cases than among the relatives of adult onset cases. Moreover, relatives of prepubertal depressed subjects had higher rates of criminality and family discord than postpubertal subjects. Prepubertal onset depressive disorders appear to be relatively distinct from postpubertal forms.

Nocturnal ACTH, Cortisol, Growth Hormone, and Prolactin Secretion in Prepubertal Depression

To examine nocturnal secretion of adrenocorticotropin, cortisol, growth hormone, and prolactin in 38 medically healthy children with prepubertal major depression compared with 28 medically and psychiatrically healthy control children. Prior to sampling, subjects underwent an "adaptation night" with the intravenous catheter in place and electroencephalographic (EEG) electrodes for standard all-night polysomnogram. On the following night, plasma samples were obtained every 20 minutes through an indwelling catheter. Hormonal concentrations were measured by specific radioimmunoassay and aligned by EEG-confirmed sleep onset. Areas under the curve were calculated for total secretion and compared using analysis of variance. Prepubertal depressed children had lower cortisol secretion during the first 4 hours after sleep onset compared with controls. Adrenocorticotropin, prolactin, and growth hormone secretion did not differ between groups. Examination of clinical characteristics in depressed children revealed lower nocturnal adrenocorticotropin concentrations in depressed inpatients versus depressed outpatients and in depressed sexually abused versus depressed nonabused children. A significant sex by diagnosis effect revealed lower growth hormone secretion in depressed females compared with depressed males. In contrast to neuroendocrine challenge studies in these same subjects, nocturnal neuroendocrine measures did not reveal any of the expected group differences. These results emphasize the contrasts between unstimulated and challenge studies of neuroendocrine secretion and of the importance of considering clinical characteristics and maturation influences in biological studies of prepubertal depression.

Teachers' assessments of prepubertal childhood depression

Teachers' reports of depression and behaviour problems were investigated in Australian prepubertal children aged 7–11 years. Teacher ratings of children in three groups were compared. The clinical depressed and clinical nondepressed children were outpatients at a Melbourne metropolitan hospital and the normal children were matched with the clinical children for age, sex, family structure, and socioeconomic status. Measures included the Childrens Depression Scale - Adult Short Form and the Children's Behaviour Questionnaire for Completion by Teachers. The results showed that teachers of children in the clinical depressed group (n = 20) reported higher levels of depression and more behaviour problems than teachers of children in the clinical nondepressed (n = 81) and normal (n = 52) groups. The findings support the capacity of teachers to identify depression in children, and suggest that depression and behaviour problems are associated in prepubertal children.

Parent-Child Agreement in Prepubertal Depression: Findings with a Modified Assessment Method

Lack of or low parent-child (P-C) agreement is a well-documented problem in child psychopathology assessment. This study proposed to improve this agreement by using a modified assessment approach. Ninety-three depressed prepubertal children, aged 6 to 12 years, and their mothers underwent an assessment procedure that combined multiple assessment measures given separately to child and mother (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present Episode [K-SADS-P], Children's Depression Inventory, and traditional psychiatric interviews), confrontation of either and/or both informants with intra- and interinformant discrepancies, and senior clinician's "best estimate" clinical judgment to solve discrepant ratings. Correlational statistics (r, kappa, and z) were used to compare child's with mother's ratings on 20 K-SADS-P depressive symptoms. The major hypothesis, that using our assessment procedure, P-C agreement would be significant and moderately high (r and kappa = .40 or higher), was confirmed. The second hypothesis on dissociation of P-C agreement on behavioral versus ideational symptoms was partially confirmed; the third hypothesis on adverse effects of maternal "depression" on P-C agreement was not confirmed. Our assessment method has potential clinical application in enhancing diagnostic reliability of childhood depression assessment.

Predictors of Later Hypomania and Mania in Prepubertal Major Depression

Predictors of Later Hypomania and Mania in Prepubertal Major Depression

Thyroid Stimulating Hormone Response to Thyrotropin in Prepubertal Depression

In an effort to evaluate whether differences exist in the hypothalamic-pituitary-thyroid axis of depressed children, a thyrotropin releasing hormone (TRH) stimulation test was administered to 55 prepubertal subjects who were divided into three groups matched for age and sex: a depressed group (endogenous N = 15, nonendogenous N = 15), a psychiatric nondepressed control group (N = 16), and a normal control group (N = 9). Each subject was tested at two dosages of TRH, 2 micrograms/kg and 7 micrograms/kg. Increasing age and female sex were positively correlated with a greater thyroid stimulating hormone (TSH) response. TSH response to TRH was examined with subjects reclassified by severe suicidal ideation, severe aggression, and parental history of alcoholism. Results of this study are contrasted with the adult psychiatric literature.

Children of depressed parents. Increased psychopathology and early onset of major depression.

Data on the psychiatric diagnosis, overall functioning, and treatment of 220 6- to 23-year-old subjects who were at high or low risk for major depression are presented. The subjects' diagnoses were made by a child psychiatrist based on best-estimate evaluation of diagnostic information derived from structured interviews (Schedule for Affective Disorders and Schizophrenia for School-Aged Children, Epidemiologic Version) with the subjects and separately with their mothers about their children. The major findings were an increased overall prevalence of major depression and substance abuse, psychiatric treatment, poor social functioning, and school problems in the children of depressed proband parents compared with children of normal proband parents. Overall prepubertal depression was uncommon and the sex ratios were equal. After 12 years of age, there was an increasing preponderance of female subjects in the group with major depression. The mean age at onset of major depression was similar for male and female subjects. However, it was significantly earlier in the children of depressed probands (mean age at onset, 12 to 13 years) compared with the children of normal probands (mean age at onset, 16 to 17 years). Symptom profiles and additional types of diagnoses in the depressed children from either proband parent group did not differ. These children are being followed up longitudinally to determine the prognostic significance, persistence, recurrence, and recall of their symptoms. Several research and clinical strategies are suggested by these data.

Targeting imipramine dose in children with depression.

The response to imipramine (IMI) in children with depression has been shown to correlate with total levels of IMI plus its active metabolite desmethylimipramine (DMI). The pharmacokinetics of IMI + DMI in children with depression are examined, and the single-point prediction of steady-state IMI + DMI levels at minimum therapeutic concentrations for prepubertal depression is proposed. With a single, 25 mg oral dose of IMI, a plasma concentration of IMI + DMI 24 hours after dosing correlates (r = 0.92) with steady-state IMI + DMI levels in children with depression receiving 3 mg/kg/day IMI. The targeting of IMI dose in the child population with depression to rapidly achieve a minimum therapeutic concentration is shown to be feasible and reliable within theoretic limits.

Depression in pre-pubertal, children.

Pre-pubertal depression has attracted a great deal of interest recently. The literature is reviewed with a particular focus on the better designed studies. While isolated symptoms of depression are relatively common, definite depressive disorder is much less prevalent. The majority of studies have focused on the most severely depressed subgroup of children. While effective treatment regimes are being developed for this small group of children, there is no evidence that such regimes should be applied to every depressed child. Major gaps exist in our knowledge of the range of depressive symptomatology in pre-pubertal children, the relationship of developmental factors to depressive symptoms, the reliability and validity of existing diagnostic tools, and the effectiveness of traditional child psychiatric treatment modalities for depression.